This inspection took place on 25 October and 2 November 2018 and was unannounced. We previously inspected the service on 29 June and 4 July 2017 and we rated the service requires improvement. This was because the service was not meeting regulations relating to safe care and treatment, good governance and staffing. Following the last inspection we asked the registered provider to complete an action plan to show what they would do, and by when to improve the key questions of whether the service was safe, effective, caring, responsive, and well-led.During this inspection we identified the home had made some improvements. People had appropriate risk assessments for how they were supported to move. Staffing levels were appropriate to support people’s needs and were reviewed regularly. However, the service remained in breach of regulations relating to safe care and treatment, good governance and staffing. We found the service had failed to identify inaccuracies in certain aspects of the home’s management and staff did not receive regular supervisions and appraisals. This is the third time the service has been rated as requires improvement overall. You can see what action we told the provider to take at the back of this report.
Roberttown Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Roberttown Care Home provide care and support to older people, some of whom are living with dementia. The home has a maximum occupancy of 29 people. On day one of our inspection there were 25 people living at the home and on day two of our inspection there were 26.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People told us they felt safe and staff were aware of the importance of reporting concerns to senior staff. The records kept by the service did not always evidence how the registered manager responded to these concerns.
Care plans contained individualised risk assessments, however not all had adequate information to ensure people’s care and support was safe. Personal emergency evacuation plans (PEEPs) did not contain up to date information.
Premises were maintained safely and appropriate checks completed.
Systems were in place to reduce the risk of employing staff who may not be suitable to work with vulnerable people, however in some instances gaps in people’s employment history had not been checked.
An electronic medicines administration record (EMAR) was in place to monitor and manage the administration of medicines. This was used safely however the administration of topical creams were not always recorded consistently.
New staff received an induction to the home which included mandatory training and shadowing more experienced colleagues. Staff received ongoing training, however they did not have access to regular supervisions and appraisals.
Mental capacity assessments were decision specific and people were deprived of their liberty lawfully. Staff awareness of mental capacity was good.
People were offered a good choice of meals. Their nutritional risks were assessed and weight loss monitored and appropriate action taken when necessary.
People had appropriate and timely access to external healthcare professionals.
People told us staff were caring and kind. Staff were knowledgeable about people and encouraged people to make choices about their daily lives and retain a level of independence. Staff were aware of the need to maintain people’s privacy, dignity and confidentiality, however we observed on two occasions people’s records were not always locked away.
People’s care plans were person-centred and detailed and although regular reviews of people’s care took place people’s care plans were not always updated to reflect their current care and support needs. The actions the service took to meet these needs was not always recorded in people’s daily records.
There was a good range of activities and people received one-to-one activity time on a daily basis.
People were aware of how to complain. Although the registered manager responded to verbal concerns they did not record these.
People were asked about how they would like to be cared for at the end of their life and their wishes were recorded.
Staff had mixed opinions about how well the registered manager managed the home. Minutes of staff meetings did not record any feedback given by staff about the service or show their involvement had been sought in making improvements.
A range of audits were completed on a regular basis to assess the quality and safety of the service, however some audits were not effective. They had failed to identify the issues we found during this inspection. Where responsibility for audits had been delegated, staff had not received appropriate training to complete these audits effectively.
The registered manager compiled a monthly report which recorded a variety of information relating to the day to day running of the home. A senior manager regularly visited the home and audited the quality of the service people received. However, some of these systems of governance had failed to identify the issues we have evidenced within our report.